DESCRIPTION: Specific Aims: The proposed project will develop an innovative mathematical tool to guide health planners in maximizing access to their State emergency medical services systems. A related mathematical tool, The Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH), has been recently completed by three of the proposed project's Investigators under a grant from the Agency for Healthcare Research and Quality. The TRAMAH can be used to locate both trauma centers and helicopter depots for State trauma care systems. The operations research work proposed here will meaningfully build on the original TRAMAH by adding hospital volume constraints to the model and then applying it in multiple States. We will accomplish this goal through the following specific aims: (1) DATA AIM - The extraction, calculation, and compilation of geographic data pertaining to severely injured individuals, trauma care facilities, and travel times in 12 States that participate in the Healthcare Cost and Utilization Project State Inpatient Databases; (2) FORMULATION AND TESTING AIM - The formulation and assessment of a new operations research model to simulate the optimal locations of trauma center hospitals and the ambulances that serve these hospitals; and (3) APPLICATION AIM - The application, of the new model to 12 State trauma care systems using the previously compiled geographic data in order to make comparisons between these States and to assess the model's flexibility as a tool for future trauma systems planning and evaluation. Research Design and Methods: The new operations research model will make use of linear, integer, and heuristic programming in formulating its objective. Testing of the new model formulation will be conducted on a series of synthetic datasets of increasing size. To study the trauma care offered to severely injured individuals, hospital discharge, vital statistics, census, and health facilities data from 1995 and 1996 will be used in applying the new model in 12 States. These States have been selected as a reasonable cross-section of all U.S. States. Analyses will then be completed to compare the efficiency of each State trauma care system in terms of resources and patient access as well as demographic indicators, economic indicators, and the existence of a well-developed trauma system. Long-Term 0bjectives: The results of this project will offer valuable insight to State policymakers interested in improving their trauma care systems through optimal location of their trauma centers and helicopter depots. Based on their remote geography and general lack of access to trauma centers, rural and frontier areas will greatly benefit from the project's objective of creating more efficient trauma care systems. In addition, the results of this project will lay the foundation for future applications of the new operations research model through the development of quantitative planning processes designed to interact with and iteratively incorporate input from State trauma systems planners.